Ariz. Admin. Code § R4-6-301 - Application for a License by Examination

An applicant for a license by examination shall submit a completed application packet that contains the following:

1. A statement by the applicant certifying that all information submitted in support of the application is true and correct;

2. Identification of the license for which application is made;

2. 3. The license application fee required under R4-6-215;

3. 4. The applicant's name, date of birth, social security number, and contact information;

4. 5. Each name or alias previously or currently used by the applicant;

5. 6. The name of each college or university the applicant attended and an official transcript for all education used to meet requirements;

7. Verification of current or previous licensure or certification from the licensing or certifying entity as follows:

a. Any license or certification ever held in the practice of behavioral health; and

b. Any professional license or certification not identified in subsection (7)(a) held in the last 10 years;

8. Background information to enable the Board to determine whether, as required under A.R.S. § 32-3275(A)(3), the applicant is of good moral character;

9. A list of every entity for which the applicant has worked during the last 7 years;

10. If the relevant licensing examination was previously taken, an official copy of the score the applicant obtained on the examination;

11. A report of the results of a self-query of the National Practitioner Data Bank;

12. Documentation required under A.R.S. § 41-1080(A) showing that the applicant's presence in the U.S. is authorized under federal law;

13. A completed and legible fingerprint card for a state and federal criminal history background check and payment as prescribed under R4-6-215 if the applicant has not previously submitted a full set of fingerprints to the Board, or verification that the applicant holds a current fingerprint card issued by the Arizona Department of Public Safety; and

14. Other documents or information requested by the Board to determine the applicant's eligibility.

Notes

Ariz. Admin. Code § R4-6-301

New Section made by exempt rulemaking at 10 A.A.R. 2700, effective July 1, 2004 (Supp. 04-2). Amended by exempt rulemaking at 11 A.A.R. 2713, effective June 27, 2005 (Supp. 05-2). Amended by exempt rulemaking at 21 A.A.R. 2630, effective 11/1/2015. Amended by exempt rulemaking at 22 A.A.R. 3238, effective 11/1/2016. Amended by final rulemaking at 24 A.A.R. 3369, effective 1/12/2019.